Kang Mandip Singh, Sandhu Charnjeet Singh, Singh Natasha, Evans Timothy
Internal Medicine, UCSF, Fresno, California, USA.
Pulmonary Medicine and Critical Care, UCSF, Fresno, California, USA.
BMJ Case Rep. 2019 Aug 30;12(8):e230601. doi: 10.1136/bcr-2019-230601.
A 31-year-old man with a recent diagnosis of hypothyroidism presented to the emergency department as a transfer from the clinic for severe hypotension and hypoglycaemia. The patient endorsed a 2-week history of severe fatigue, weight loss, nausea and non-bloody emesis. He was aggressively hydrated and vasopressors were initiated. Despite these measures, the patient remained hypotensive and went into pulseless electrical activity. Return of spontaneous circulation was achieved via advanced cardiac life support protocol, and venous arterial extracorporeal membrane oxygenation (ECMO) was initiated. On day 3 of hospitalisation, the patient was weaned off ECMO support, and subsequent autoimmune work-up confirmed the diagnosis of autoimmune polyglandular syndrome type 2 with positive antiperoxidase antibodies (267 IU/mL), supporting the diagnosis of Hashimoto's thyroiditis.
一名31岁男性，近期诊断为甲状腺功能减退，因严重低血压和低血糖从诊所转诊至急诊科。患者自述有2周的严重疲劳、体重减轻、恶心和非血性呕吐病史。给予积极补液并开始使用血管升压药。尽管采取了这些措施，患者仍处于低血压状态，并出现了无脉电活动。通过高级心脏生命支持方案实现了自主循环恢复，并启动了静脉-动脉体外膜肺氧合（ECMO）。住院第3天，患者撤下ECMO支持，随后的自身免疫检查确诊为2型自身免疫性多腺体综合征，抗过氧化物酶抗体阳性（267 IU/mL），支持桥本甲状腺炎的诊断。
